title: Mediational effects of self-efficacy dimensions in the relationship between knowledge of dengue and dengue preventive behaviour with respect to control of dengue outbreaks: a structural equation model of a cross-sectional survey.
abstract: BACKGROUND
  Dengue fever is endemic in Malaysia, with frequent major outbreaks in urban areas. The major control strategy relies on health promotional campaigns aimed at encouraging people to reduce mosquito breeding sites close to people's homes. However, such campaigns have not always been 100% effective. The concept of self-efficacy is an area of increasing research interest in understanding how health promotion can be most effective. This paper reports on a study of the impact of self-efficacy on dengue knowledge and dengue preventive behaviour.
  
  
  RESULTS
  We recruited 280 adults from 27 post-outbreak villages in the state of Terengganu, east coast of Malaysia. Measures of health promotion and educational intervention activities and types of communication during outbreak, level of dengue knowledge, level and strength of self-efficacy and dengue preventive behaviour were obtained via face-to-face interviews and questionnaires. A structural equation model was tested and fitted the data well (χ(2) = 71.659, df = 40, p = 0.002, RMSEA = 0.053, CFI = 0.973, TLI = 0.963). Mass media, local contact and direct information-giving sessions significantly predicted level of knowledge of dengue. Level and strength of self-efficacy fully mediated the relationship between knowledge of dengue and dengue preventive behaviours. Strength of self-efficacy acted as partial mediator in the relationship between knowledge of dengue and dengue preventive behaviours.
  
  
  CONCLUSIONS
  To control and prevent dengue outbreaks by behavioural measures, health promotion and educational interventions during outbreaks should now focus on those approaches that are most likely to increase the level and strength of self-efficacy.
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
authors.forename: Affendi
authors.initials: A
authors.lastname: Isa
authors.forename: Yoon K
authors.initials: YK
authors.lastname: Loke
authors.forename: Jane R
authors.initials: JR
authors.lastname: Smith
authors.forename: Alexia
authors.initials: A
authors.lastname: Papageorgiou
authors.forename: Paul R
authors.initials: PR
authors.lastname: Hunter
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods; D003430:Cross-Sectional Studies; D003715:Dengue / Q000453:epidemiology* / Q000517:prevention & control*; D004196:Disease Outbreaks; D005260:Female; D006266:Health Education / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020377:Self Efficacy